Diabetes and Carb Counting For Dummies (For Dummies (Lifestyle)) 1st Edition

Chapter 5

Finding Your Sweet Spot: The Right Amount of Carbs for You

IN THIS CHAPTER

Reviewing established nutrition guidelines

Basing carb targets on caloric needs

Knowing when to alter your carb plan

When it comes to diabetes, the age-old question is whether an ideal fuel mix exists: Is there a best ratio of carb, protein, and fat to eat? Studies fail to identify a specific diet pattern that should be prescribed to everyone with diabetes. Diet recommendations should be individualized. However, everyone should strive to consume wholesome foods in reasonable portions because a nutritionally complete diet and weight control improve health outcomes. Favor foods that are less processed and have more fiber. Limit refined grains and cut down on saturated fats, added sugars, and salt. The body definitely needs carbs, but not everybody needs the same amount.

This chapter provides charts and tables to help you estimate your caloric needs and to personalize your carbohydrate intake goals. First, though, I briefly review general nutrition guidelines from several reputable sources.

Checking Out the Official Diet Guidelines

Popular diets come and go. Well-respected health experts share the opinion that the best diets are balanced, nutritionally complete, and sustainable for the long run. The following institutions have been studying outcomes, setting standards, and forming nutrition policy for many decades. People with diabetes can look to the experts for dietary guidance.

Advice from the American Diabetes Association

The American Diabetes Association (ADA) says that diet plans should be individualized while keeping in mind calorie goals and other health conditions. They encourage choosing carbohydrates from whole grains, vegetables, fruits, legumes, and dairy sources. They suggest limiting sugary foods and completely avoiding sugar-sweetened beverages.

The ADA doesn’t make a specific recommendation about how much carb should be consumed, but by observation they note that people with diabetes tend to eat about 45 percent of their calories as carbs. They report that there is no clear evidence that supplementation with vitamins, minerals, herbs, or spices can improve diabetes. The ADA encourages people with diabetes to adhere to the dietary guidelines for the general population when it comes to fat intake, and it does not set rigid standards for dietary protein intake. For more info, log on to www.diabetes.org and click on the Food & Fitness tab.

The 2015–2020 Dietary Guidelines for Americans

Every five years the U.S. Departments of Health and Human Services (HHS) and of Agriculture (USDA) publish a report containing nutrition guidelines for the general public. These guidelines encourage a variety of nutrient-dense foods including whole grains, fruits, vegetables, nonfat and low-fat dairy products, lean meats, poultry, seafood, eggs, oils, legumes, nuts, and seeds. They suggest limiting solid fats, added sugars, refined starches, and sodium.

The portioning guidelines are embodied in the “Choose MyPlate” image. Half of the plate is divided between vegetables and fruits; just over one-fourth of the plate is for grains, just under one-fourth of the plate is for lean proteins, and a serving of low-fat or nonfat dairy can accompany the meal. They suggest that at least half of the grain servings should be whole grains. You can access more information at www.choosemyplate.gov .

Intakes and allowances from the National Academy of Sciences

Dietary Reference Intakes (DRI): Recommended Dietary Allowances (RDA) are set by the Food and Nutrition Board of the Institute of Medicine, National Academy of Sciences. They determine gender-specific nutrient-intake targets for vitamins and minerals across the various age ranges. They suggest a carbohydrate intake of between 45 and 65 percent of total daily calories. This range is considered the Acceptable Macronutrient Distribution Range (AMDR). The Recommended Dietary Allowance sets a minimum intake target of 130 grams of carb per day for ages one year old and above. The AMDR is 10–35 percent of daily calories for protein and 20–35 percent for fat.

Figuring Out Calorie and Carbohydrate Intake Targets

Body size, gender, age, weight goals, health status, and physical activity determine how many calories and how much carb you need. This section provides tools for setting carb intake targets based on your caloric need.

Estimating your caloric needs

Tables 5-1 and 5-2 can be used to determine caloric needs. There are two separate tables: for women (Table 5-1 ) and men (Table 5-2 ). Find your age range in the left column and then choose your activity level to locate your estimated caloric needs. Sedentary means only the light activity typical of day-to-day life and no additional exercise. Moderately active includes walking about 1.5 to 3 miles per day, and active means walking more than 3 miles per day. Other forms of exercise can be considered instead of walking.

TABLE 5-1 Estimated Caloric Needs for Women by Age and Activity

Source: Office of Disease Prevention and Health Promotion, www.health.gov

TABLE 5-2 Estimated Caloric Needs for Men by Age and Activity

Source: Office of Disease Prevention and Health Promotion, www.health.gov

Tables 5-1 and 5-2 consider only three variables: gender, age, and activity level. Therefore, they approximate your caloric needs. Apps and online calculators that also consider your height and weight can provide a more accurate estimate of actual needs:

· See the United States Department of Agriculture’s list of medical calculators available at https://fnic.nal.usda.gov/dietary-guidance/interactive-tools/calculators-and-counters .

· Calculate exact body mass index (BMI) online at this link or using any other BMI calculator: www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmi-m.htm . Find out more about BMI in the next section.

Adjusting calories for your weight target

Body mass index (BMI) compares weight to height and is an easy tool for estimating weight status for men and women, as shown in Figure 5-1 . Locate your height in the left column and follow the horizontal line to the right to find the weight that is closest to your weight. From that weight, follow the column directly up to find your BMI.

© John Wiley & Sons, Inc.

FIGURE 5-1: Body mass index table.

The key to interpreting BMI is as follows:

Keep in mind that BMI doesn’t differentiate between lean muscle and body fat. A muscular athlete might have a high BMI but be totally fit. The calorie target in Table 5-1 (for women) or Table 5-2 (for men) is the number of calories needed to maintain your current weight. If you desire weight loss based on your BMI result, you should reduce your caloric intake. One pound of body fat stores about 3,500 calories. Weight loss occurs when you consume fewer calories than you burn. To lose one pound per week, you would need to use 500 calories from body fat stores each day. For example, if Table 5-1 indicated you need 2,000 calories per day to stay the same weight, then you could consume 1,500 calories per day to lose weight. Tapping into 500 calories from body fat every day would lead to losing one pound per week. If you only reduce your intake by 250 calories per day, you can be on your way to losing half a pound per week.

Deciding on carb intake targets

I discuss the Dietary Reference Intakes (DRI) for Americans earlier in this chapter. The DRI minimum for carbohydrate is 130 grams per day, and the suggested carb intake range is calculated at 45–65 percent of caloric targets. Some people with diabetes opt to go somewhat lower, such as 40 percent. Targets should be individualized based on preference and health considerations.

After you’ve estimated your caloric needs using Table 5-1 or Table 5-2 or by using an online calorie calculator, you’re ready to use the chart in Figure 5-2 to estimate carbohydrate intake targets. Find your desired calorie level in the left column. Decide what percentage of your daily calories you want to allocate to carbohydrate as indicated along the top row, from 40–65 percent. (Note the suggested minimum carb intake per DRI guidelines is 130 grams per day, so the table doesn’t go below that number.)

© John Wiley & Sons, Inc.

FIGURE 5-2: Daily carb intake targets by calorie levels.

If your blood-glucose levels are running above target, it may be wise to choose a lower level of carb until control improves. Gaining control of your diabetes may require diet modifications, exercise, and medications. Once medications are properly adjusted, I usually suggest starting with 45–50 percent of daily calories as carbs. If you prefer a lower carb intake, 40–50 percent is fine. The lowest carb intake in the table is 130 grams per day to comply with the minimum dietary intake recommended by the National Institutes of Health. If you’re active and can control blood-glucose levels while eating more carbs, then you may aim for carb intakes of 50–55 percent of calories. It may be difficult to control blood-glucose levels with 60–65 percent of your calories from carb unless you are an athlete who is getting a lot of exercise.

Here’s an example using Figure 5-2 : Consider a moderately active person who wants to eat 1,600 calories each day and opts for 40–50 percent of calories to come from carbs. Locate the 1,600-calorie level in the far left column. Find the column headings for 40–50 percent. Line up the horizontal 1,600 calorie line with the vertical 40–50 percent columns. The daily carb intake goal would be 160–200 grams. Blood-glucose levels will be best controlled if the carbs are budgeted between meals and snacks. (See the next section for more information.)

Distributing carb intake

Having a daily carb budget in mind is helpful, but even more helpful is to have an idea of how many carbs to eat at each meal and snack. (Snacks are not required. ) Consider two women who each have chosen to aim for 150 grams of carb per day. They both have type 2 diabetes and take the same type of oral medication.

· Natalie skips breakfast, has 30 grams of carb for lunch, and then she eats the remaining 120 grams of carb for dinner. Not surprisingly, she has significant blood-glucose elevations in the evening.

· Cassie, on the other hand, divides her carbs more evenly and has 40 grams of carb at breakfast, 50 grams at lunch, and 60 grams at dinner. She finds it much easier to control her blood-glucose levels because she spreads her carb intake into manageable amounts.

See Chapter 6 for guidelines on establishing carb intake targets at meals.

WHY DEALING WITH HIGH-CARB MEALS CAN BE HARD

Type 2 diabetes means your insulin doesn’t work as well as it should. The more carb you eat at one time, the higher the blood glucose is likely to go because glucose levels build up in the blood while waiting for their turn to get transported into the cells. It can take many hours for the elevated glucose levels to resolve. (See Chapter 4 for more details.)

Even if you take pills to treat your diabetes, you still need to limit how much carb you consume at one time. You can out-eat any medication, including insulin. Even insulin has its limitations. The action times of the insulin and the digestion timing of the meal must match so that the insulin is working while the foods are digesting. (See Chapter 6 for more on the importance of timing.)

Carbohydrates are a very important part of a balanced diet, but they are best tolerated when distributed between three main meals. Small snacks may be included if you’re hungry between meals or as needed to support exercise or prevent hypoglycemia.

Leaving room on your plate for protein and fat

Although this chapter focuses on establishing a reasonable carbohydrate intake, a balanced diet also requires appropriate intakes of protein and fat. It pays to limit saturated fats, so opt for lean protein sources. The type of fat found in fatty cuts of meat is linked to heart disease. A reasonable portion of meat is roughly the same size as the palm of your hand. Another heart-healthy tip is to choose liquid oils in place of solid fats.

Chapter 8 provides portioning tips, and Chapter 13 elaborates on choosing healthy foods. See Appendix A for a list of lean proteins and heart-healthy fats. See Part 5 for menu ideas.

Tweaking Your Carb Intake Target When Conditions Change

Carbohydrate requirements can change throughout life. Your carb demands may even change seasonally if your activity levels vary according to the time of year. The following sections explore situations that may call for making adjustments to your carb intakes.

Changing needs throughout the life cycle

Childhood and adolescence are times when dietary needs are constantly changing. It is important that children with diabetes get the same amount of nutrition and carbs as recommended for all children. Hormones and changing activity patterns call for more frequent visits with the diabetes team to make sure insulin and other medications are adjusted as needed to support a balanced and adequate diet.

Pregnancy and breastfeeding increase the demand for carbohydrates and other nutrients, so close monitoring is required with a team of experts who specialize in high-risk pregnancies.

Elderly individuals typically see a decrease in their calorie and carbohydrate needs as metabolism changes. Their vitamin and mineral needs don’t shift much, however, so they need to focus on nutrient-dense food choices.

Flip to Chapter 17 for details on managing diabetes during different life stages.

Altering intake to account for activity

Varying activity is a typical reason for adjusting carb intake. Exercise uses up more calories in the forms of carb and fat, so needs change on active days. If you aren’t at risk for hypoglycemia, you may not need or want a snack, especially if you’re trying to lose weight. If you’re at risk for low blood glucose due to insulin use or other medications, you can monitor blood-glucose levels to decide whether you need to add a snack to prevent hypoglycemia. You should always carry carbs to eat as needed and quick forms of sugar or juice for treating lows. Insulin doses can be adjusted on active days to reduce the risk of hypoglycemia. Speak to your healthcare provider for tips on medication. For more info on exercise, see Chapter 14 .

Adjusting portions when blood glucose is out of control

The American Diabetes Association sets pre-meal blood-glucose targets at 70–130 milligrams per deciliter (mg/dl) and post-meal blood-glucose targets at under 180 mg/dl. What should you do if your blood glucose level is significantly elevated, perhaps even above 180 mg/dl before eating?

Your own insulin, as well as any insulin that is injected, doesn’t work as effectively when you’re hyperglycemic. Follow your doctor’s advice about how to adjust insulin to correct glucose elevations. Limit carbs and fill up more on salad, nonstarchy vegetables, and protein foods to give your blood glucose a chance to return to target levels. If you’re frequently above target before meals, you likely need a medication tune-up and should see your doctor for advice. You can’t be expected to skip carbs on a regular basis.

Managing sick days

Being sick can make diabetes management a real challenge. Talk to your healthcare providers in advance to make a plan about how to manage illness. Your body responds to illness with stress hormones, which can cause blood-glucose levels to rise. Monitor your blood-glucose levels more frequently when you’re sick. People with type 1 diabetes should be monitoring their glucose levels at least every four hours, and people with type 2 should check at least four times daily when sick. Illness increases the risk of producing ketones, so people with type 1 diabetes should have supplies for checking ketones. You’re less likely to have ketones if you have type 2 diabetes, but it is possible if you’re very ill.

Stick to your usual meal plan if possible. Staying hydrated is important, but that can be difficult to do if you have vomiting or diarrhea. Keep sipping fluids. Choose noncarb fluids, including water, diet drinks, broth, and tea. If you can’t eat normal foods, try substituting bland foods such as crackers, toast, cooked cereals, boiled potatoes, soups, yogurt, pudding, applesauce, and canned fruits.

If you can’t handle solids, get your carbs from liquids, such as diluted fruit juices, sports drinks, gelatin, popsicles, sherbet, and soft drinks (regular — not diet — in this case).

Vomiting, diarrhea, persistently elevated blood-glucose levels, difficulty breathing, dehydration, or having ketones are all reasons to seek medical attention.

Discuss sick-day management with your doctor. Make a plan in advance. Ask your doctor for the appropriate phone numbers for whom to contact after hours and on weekends. Don’t stop taking your diabetes medications when you’re sick. Illness can cause blood-glucose levels to rise even if you aren’t able to keep any food down. People with type 1 diabetes may require even higher than usual doses of insulin during illness.